Diabetes in children: symptoms therapy

Diabetes in children has usually type 1 diabetes. This is a so-called autoimmune disease, in which the insulin-producing cells in the pancreas are destroyed by the body's own defense processes. The disease is not curable. However, with optimal blood glucose control, young patients can lead a near-normal life. Read all the important information about diabetes in children!

Diabetes In Children

Diabetes in children: description

Most diabetes is based on an autoimmune reaction in infants, children, and adolescents. This is directed against cells of the pancreas, the so-called beta cells. Sometimes type 1 diabetes also refers to pediatric diabetes.

Because of the damaged beta cells, the pancreas can only form little or no insulin. However, insulin is necessary to pass sugar from the bloodstream into the cells. In contrast, the blood sugar level rises sharply. The insulin deficiency must be compensated by those affected lifelong by injecting insulin.

Meanwhile, more and more children and adolescents have a typical risk profile for type 2 diabetes: lack of exercise, obesity and very high sugar and a fatty diet. In the past, type 2 diabetes was almost exclusively found in older adults, and children are now getting sick of it.

Diabetes in children usually occurs between the ages of 12 and 24 and is increasing in frequency in recent years. In Germany, it is estimated that about 30,000 children and adolescents up to the age of 19 suffer from type 1 diabetes. The cause of the increase is unclear, while for type 2 diabetes, an unhealthy lifestyle with obesity and lack of exercise is considered the cause.

Diabetes in children: symptoms

“Diabetes in children” often only shows symptoms when more than 80 percent of insulin-producing beta cells are destroyed. Before the insulin residual amount is sufficient to prevent a complete derailment of the sugar metabolism.

However, the symptoms of type 1 diabetes in children may develop within a few weeks. This includes:

• large urine volumes, nocturnal urination or wetting
• Extreme thirst and drinking of several liters per day
• Dullness and poor performance
• Weight loss with constant cravings (children with type 1 diabetes are usually slim.) severe abdominal pain.
• In the advanced stage, a typical acetone smell (such as "nail polish remover") of exhaled air

In contrast, the symptoms of the much rarer type 2 diabetes in children develop slowly. They are similar, but these diabetes children usually develop a significant overweight.

Diabetes in children: causes and risk factors

The causes of type 1 diabetes in children are fundamentally different from those of type 2, which is very rare at this age. In the latter case, an unhealthy lifestyle with a too high-energy diet and lack of exercise and a genetic tendency develop the development of so-called insulin resistance (insulin) the body cells no longer has a sufficient effect), there is an autoimmune disease in children with type 1 diabetes. It destroys pancreatic beta-cells, which are specialized in insulin production, thus depriving the body of insulin.

Various autoantibodies are blamed for tissue destruction. For example, about 90 percent of those affected have "IA-2 autoantibodies" and "GADA antibodies" detectable.

Doctors also differentiate between a number of special forms of diabetes, which are grouped under the label Diabetes Type 3. These include the MODY (Maturity Onset Diabetes of the Young), a special form in which the typical symptoms of type 2 diabetes occur, but those affected are usually slim and under 25 years old.

Risk factors for diabetes in children (type 1)

It is still not clear why the immune system produces autoantibodies against one's own pancreas. Researchers suggest that various factors contribute to this. These include mainly genetic causes, but also environmental factors:

Genetic causes

In about ten percent of affected children, another family member also suffers from type 1 diabetes. Diabetes in children is thus classified as hereditary, with about 20 different gene alterations identified so far. Even though most of the time several gene changes are present at the same time, some patients already have enough to develop diabetes.

Environmental factors

Also, various environmental factors seem to cause the production of autoantibodies. Thus, an association of diabetes in children with a vitamin D deficiency is suspected. Frequent recurrent respiratory infections are also suspected of triggering the disease. Infection of the mother during pregnancy with rubella, herpes or the cytomegalovirus is also discussed as a potential risk factor for childhood diabetes.

Diabetes in children: examinations and diagnosis

The right contact person for suspected diabetes in children is a pediatrician or a specialist in internal medicine and endocrinology. He may ask you the following questions in the first interview:

• Has your child been remarkably tired lately?
• Does it often need water or does it wet at night?
• Is it drinking more often or is it often complaining of thirst?
• Is it complaining about abdominal pain?
• Did you notice a fruity smell (like "nail polish remover") of the breath?
• Is another family member suffering from diabetes?

Physical examination and blood glucose measurement

Subsequently, the doctor will examine the child and usually arrange another appointment for (morning) blood sampling, in which the child must be sober. It must not have eaten for at least eight hours and have not taken any sugary drinks so that the fasting blood glucose value can be reliably determined. The diagnosis of diabetes in children should be confirmed by at least two fasting blood glucose determinations to rule out measurement errors and fluctuations.

Long-term blood glucose (HbA1c)

A poorly adjusted diabetes in children is associated with permanently elevated blood sugar levels. The sugar molecules circulating in the blood also become attached to the red blood pigment (hemoglobin) and "sugared" (glycosylated) hemoglobin is formed. Its percentage of total hemoglobin can be determined in the laboratory and is given in percent as "HbA1c value". Values ≥ 6.5 percent are very likely to be diabetes. Since the HbA1c value is independent of individual fluctuations of the day and makes it possible to predict the glycemic control of the last eight to twelve weeks, it is considered a valuable diagnostic tool. He will later be used to control the success of the treatment.

Diabetes in children: treatment

Immediately after the diagnosis of diabetes, the children and their parents should receive special diabetes education. You will learn which carbohydrate quantities different foods have and how much insulin the body needs at what time of the day for which foods. The young patients learn to assess their own insulin requirements and inject the right amount of insulin at the right time. Dose and time are very important so that life-threatening hypoglycemia (hypoglycemia) or high blood sugar levels can be prevented.

Type 1 diabetes requires lifelong insulin injections because the pancreas itself can not produce insulin. As a rule, insulin is injected today as part of intensified insulin therapy. This means that the insulin intake is adjusted beyond a basic dose of insulin to the current need (food intake, physical activity, etc.). Especially in children and adolescents today, the insulin pump is increasingly used, which can be flexibly and quickly controlled.

Intensified insulin therapy (basic bolus principle)

The type 1 diabetes i

n children should always be treated with the aim to adjust the blood glucose levels in a possible constant range of about 100mg / dl. As a rule, long-acting insulin is injected twice a day, which covers half of the daily requirement (basis). The patients measure the current blood sugar shortly before a meal and then inject another normal or short-acting insulin (bolus). The required bolus quantity depends on the time of day and the composition of the meal. The better the patient is able to adjust the blood sugar, the sooner the serious long-term consequences of diabetes in children can be prevented.

insulin Pump

The insulin pump is particularly suitable for children to maintain the quality of life despite diabetes. A fine catheter is implanted in the abdominal fat, which is connected to the insulin pump via a small tube. The insulin pump can be attached to the belt or in a small pocket under the shirt around the neck and is therefore not visible from the outside.

It is personalized in a specialized diabetes practice or clinic so that it can deliver predetermined amounts of insulin into the fatty tissue throughout the day. From there it passes through the finest blood vessels in the entire body. With meals, insulin can also be delivered at the push of a button. The affected person is given a lot of freedom by the insulin pump. Most patients get used to the pump very quickly. In addition, it relieves the children with diabetes significantly, because the daily painful insulin injections are eliminated. The insulin pump can always be worn, even while playing sports or playing games. If necessary - for swimming, for example - the pump can also be decoupled.

Type 2 diabetes in children: lose weight and become active

In addition to the treatment of the actual disease, it is important for children with type 2 diabetes to reduce the risk factors. Parents should motivate their children for regular physical activity and avoid "nutritional sins" as much as possible. It is not uncommon for diabetes-type 2 children to relinquish their medication at reduced body weight and enough exercise. However, one must keep the blood sugar levels in the eye even further, since the tendency to diabetes persists. Basically, children with massive overweight should be clarified early, if necessary, an eating disorder or a hormonal cause is responsible.

Diabetes in children: disease course and prognosis

In type 2 diabetes, the course of the disease depends crucially on whether the children and adolescents change their lifestyle. More exercise, energy-reduced nutrition, and weight loss can sometimes make diabetic children disappear completely.

Unlike sometimes with type 2 diabetes is not curable in children with type 1 so far. Regularly updated training and medical supervision are therefore essential. The main goal is to achieve as constant as possible a high blood glucose level through the intensified insulin therapy in order to avoid secondary diseases. The younger the patients are at the onset of diabetes, the higher the risk of consequential damage during life.

The most common complications include damage to blood vessels (diabetic angiopathy) and nerves (diabetic polyneuropathy). Damage to the kidney and eyes is also a common complication after several years of poorly controlled diabetes. Apart from that, insulin therapy may lead to hypoglycemia (hypoglycemia) or ketoacidosis or coma.